MEDICARE: MRS. KRISTEN MARIE PETTINATO LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC012874	PA

General Provider Information

NPI Number	:	1568055234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTEN MARIE PETTINATO LPC

Provider Business Mailing Address
First Line	:	808 DOGWOOD LN
Second Line	:
City	:	COLLEGEVILLE
State	:	PA
Zip	:	19426-4122
Country	:	US
Telephone Number	:	610-608-9508
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 OLD SWEDE RD
Second Line	:
City	:	DOUGLASSVILLE
State	:	PA
Zip	:	19518-1852
Country	:	US
Telephone Number	:	610-910-8500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2021
Last Update Date	:	02/14/2021

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